Deep-six the doc fix

In brief: Time after time over the last decade, the money collected by doctors for treating Medicare patients has faced huge cuts under a complicated formula created by Congress. The formula sets limits on Medicare's overall spending for physician services. If that limit is exceeded, a fee cut is supposed to kick in.

Every time a fee cut has loomed, though, doctors have screamed and lawmakers have caved. They've suspended the pay cut. Washington has come to know this as the doc fix.

It's time to pull the plug on this whole thing. The regular threat of a pay cut encourages doctors to refuse new Medicare patients. One in four Medicare patients looking for a new primary care doctor has trouble finding one, according to the Medicare Payment Advisory Commission.

The doc fix allows Congress to claim it has trimmed Medicare spending without actually doing it. That 27 percent pay cut, for instance, has already been booked in federal spending and deficit projections. It artificially reduces spending estimates because it's a phantom cut.

This is big money. If Congress repealed the Medicare formula today, the cost would be about $290 billion over the next 10 years, the Congressional Budget Office says. That's a lot of doc fixing.

Lawmakers on both sides of the aisle, however, don't want to tackle a solution to this, and don't want to acknowledge that honest accounting of future Medicare costs would add $290 billion in looming debt.

The AMA recently outlined its solution: Congress should use "projected spending that will not be needed as the wars in Iraq and Afghanistan wind down to help pay for ensuring access to health care for military and seniors."

Say what?

The U.S. will spend less in the future on operations in Iraq and Afghanistan. But that's not money in the bank. It's simply money that won't have to be borrowed.

Yet there's a long line forming to spend that imaginary money, starting with President Barack Obama, who said Tuesday he wants to take the money no longer being spent on war and "use half of it to pay down our debt, and use the rest to do some nation-building right here at home."

Note to the president and to the AMA: This is all borrowed money. We're in debt.

So what do we do with Medicare fees to doctors? It's not as easy as the AMA would make it out to be.

"To actually pay for the doc fix would require real savings, and this gimmick would not produce any real savings," says Josh Gordon of the Concord Coalition.

The influential Committee for a Responsible Federal Budget chimes in: "The first rule when you're in a hole is to stop digging and making the problem worse. It is also a good idea not to cover the hole with leaves and advertise it as filled."

Lawmakers, stop pretending that you will someday dun the doctors. It won't happen. Scrap the formula. Create better Medicare incentives for doctors to control costs.

Doctors should be paid to provide high quality care, not just more care. They should be rewarded for eliminating unnecessary tests and treatments. A focus on keeping patients healthy can reduce emergency room visits, shorten hospital stays and curb readmissions. That's better for doctors, patients … and the federal budget.